This audit examined compliance with best practice within a busy district general hospital (750 beds) on 1 day. Audit Measures: • First line strong opioid, morphine-exceptions, renal impairment, documented sensitivity • PRN prescribing, 1/6 of the regular dose and same compound (where applicable), dosing interval ‘up to hourly’ and specified indication of use- exception, renal impairment • Regular laxatives • Antiemetic prescription at least PRN • Prescription compliant with Trust policy Adult inpatients prescribed regular strong opioid analgesia, irrespective of route, were included in the audit. An audit proforma was completed with reference to the patient's medical records and prescription chart.
Results • 100% compliance, adherence to local Trust prescribing policy • Only 4% (29/750) of adult inpatients on the audit day were prescribed regular strong opioids, in all cases for pain relief. This figure was lower than expected and begs the question, is pain poorly assessed/poorly managed within the acute hospital environment? • 68% compliance overall with prescribing morphine first-line, 78% for those prescriptions started within the hospital • Higher ratio of prescriptions for patients with non-malignant disease- increased patch prescribing (buprenorphine, fentanyl) in this patient group • 21% (6) had no breakthrough analgesia prescribed, 65% of prescriptions met the standard, those that did not had too low a PRN dose prescribed • Mean, median and mode doses (equivalent morphine doses) 132, 60, 60mgs respectively • 89% of patients with impaired renal function had an appropriate 2nd line strong opioid prescribed but poor compliance with PRN prescribing in this patient group • Regular laxatives were prescribed in 48% patients while antiemetics were prescribed in 72% As a result of this audit practical prescribing guidance cards are being issued to all junior doctors with the plan to re-audit in 1 year's time.
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